Hypospadias Fistula

Abstract

Fistula is reported as the commonest complication after hypospadias repair. Most causes of fistula formation are technical and avoidable. The commonest cause nowadays is distal urethral narrowing due to reconstruction of a narrow incompletely epithelialized neo-urethra. Other causes include the use of hypoplastic poorly vascularized tissues, lack of protective intermediate layer, suture material and size, tissue handling, and urinary diversion. The first step in management of fistula is to exclude distal stenosis or functional obstruction, the reconstruction of wide healthy urethra, the use of protective intermediate layer, urinary diversion using silicone catheters, and avoid wet dressing. Some techniques are more prone to fistula formation. The commonest site of fistula formation is at the coronal sulcus. It is important to wait at least 6 months before fistula repair.